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Cerebrospinal otorrhea and recurring meningitis: report of three cases
Abstract:
Recurrent attacks of meningitis occurring independent of a systemic bacterial infection should be considered as a cerebrospinal leak either otorrhea or rhinorrhea. Three cases each with a different cause were diagnosed chiefly on the basis of the history and a bulging noninflammatory eardrum. Subsequent use of fluorescein intrathecally not only helped to confirm the diagnosis but was very useful at surgery in locating the leak in the dura of the oval window of the ear. Many materials have been used but autogenous temporal fascia or fascia lata seemed to be most effective in these cases. The sandwiching of the dura between two pieces of fascia is not only realistic but was found to be very effective. One piece of fascia between the arachnoid and dura and another between the dura and bone give a tight seal.
Insights
Recurrent meningitis may indicate a cerebrospinal fluid leak. Intrathecal fluorescein aids diagnosis and surgical localization of dural leaks, with autogenous fascia providing an effective seal.
Area of Science:
- Neurosurgery
- Otolaryngology
- Neurology
Background:
- Recurrent meningitis, independent of systemic infection, suggests a potential cerebrospinal fluid (CSF) leak.
- Identifying the source of CSF otorrhea or rhinorrhea is crucial for effective management.
- Traditional diagnostic methods may not always pinpoint the exact location of the leak.
Observation:
- Three cases of recurrent meningitis were analyzed, each with a distinct etiology.
- Diagnosis was primarily based on patient history and the presence of a bulging, non-inflammatory eardrum.
- Intrathecal fluorescein administration was employed for diagnostic confirmation and surgical guidance.
Findings:
- Intrathecal fluorescein successfully confirmed the diagnosis of CSF leak in all cases.
- The dye was instrumental in precisely locating the dural defect at the oval window during surgery.
- Autogenous temporal fascia or fascia lata proved highly effective for dural repair.
- A "sandwich" technique, placing fascia between the dura and arachnoid, and dura and bone, created a robust seal.
Implications:
- This approach offers a reliable method for diagnosing and surgically treating challenging CSF leaks.
- The described surgical technique and materials enhance the success rate of dural defect repair.
- Early recognition and intervention can prevent further episodes of meningitis and associated complications.